Types of Headaches

Headaches can be very different for different people. The pain may
have different qualities: throbbing, sharp or stabbing, constant or
intermittent, a dull ache. Some headaches may last only seconds or
minutes, whereas others last hours or even days.

Some headaches may be felt in the forehead, in the temples or in the
back of the neck; sometimes headaches occur just on one side of the
head. The quality, duration and location of a headache often help
health-care providers to make a specific diagnosis.

Headaches also vary in their frequency. Some peoples have rare or
infrequent headaches. Others get headaches on a regular basis, including
women whose headaches coincide with their menstrual periods.

Still others have clusters of severe headaches that occur frequently
over several weeks, then disappear for months or even years. Most
troubling are the headaches that occur frequently, or even daily, over
months or years.

There are many different types and causes of headaches. Health care
providers generally divide headaches into two major categories:

Primary Headaches

Most people who have regular headaches have one of three types of primary headaches:

Not everyone with regular headaches falls neatly into one of
these three categories. Some people have headaches that appear to share
features of more than one type of headache, and other people may have
different types of headaches at different times. For example, some
people may have occasional migraines interspersed with less severe
tension-type headaches.

Migraines

Migraines are among the most common types of recurring headaches. A typical migraine is a throbbing headache that occurs on one or both sides of the head. The headache is characteristically accompanied by nausea, vomiting or loss of appetite. Activity, bright light or loud noises may make the headache worse, so migraine sufferers (or “migraneurs”) often seek out cool, dark, quiet rooms. Most migraines last anywhere from four to 12 hours, although shorter or much longer headaches can occur.

One unique feature of migraines is a prodrome, or an unusual
sensation that a migraine is about to occur. Prodrome symptoms include
fatigue, hunger and nervousness. Migraines may also have typical
aftereffects, such as a day or two of exhaustion after a severe migraine
headache has faded. Not all migraine sufferers have prodromes or
aftereffects.

Another unique feature of migraines is the aura — a change in vision,
sound, taste or smell that comes and goes over 15 to 30 minutes and
alerts a sufferer that a headache is about to begin. Only about
one-third of migraine sufferers experience auras, and an aura may not
occur with every headache. An aura may even occur without being followed
by a headache.

Rarely, migraines can cause unusual neurological symptoms such as
dizziness, loss of vision, passing out, numbness, weakness or tingling.
Women who suffer from migraines often find that their headaches occur or
worsen around the time of their menstrual periods.

Migraines typically develop in people aged in their teens, 20s or 30s
and often “burn out” by the time a person reaches their 50s or 60s.
Sometimes symptoms are first seen in younger or older individuals.
Migraines are about twice as common in women than in men, and they tend
to run in families.

Tension-Type Headaches

Tension-type headaches are also known as tension headaches or muscle-contraction headaches. They tend to focus in the neck and back of the head, and they may wrap around the temples or forehead. Often they produce a feeling of tightness surrounding the head, similar to a hat that is too small. There may also be tenderness in the muscles of the scalp, neck and shoulders. Certain symptoms that are characteristic of migraine — particularly nausea, as well as aura — are absent in tension-type headaches.

Almost everyone has occasional tension-type headaches, making them
the most common type of primary headache. Usually, these headaches will
respond to rest or an over-the-counter pain reliever. In some people,
tension-type headaches occur frequently, even on a daily basis. Chronic
tension-type headaches may be a source of great frustration and are
often difficult to treat.

Cluster Headaches

Cluster headaches are a unique type of headache that is much less common than migraines or tension-type headaches. Men are affected about six times more often than women. The typical sufferer develops daily, excruciating headaches that occur in a “cluster” of several days to several weeks. After running their course, the headaches may disappear for months or even years. The headaches are brief — building up explosively over as little as five minutes, then lasting a total of one to three hours — but more than one headache may occur in a single day.

The pain of cluster headaches tends to center around one eye and may
spread to the rest of the face. The affected eye may become red, droopy
or tearful, and the nearby nostril may become runny or blocked. Unlike
migraine sufferers, those with cluster headache often feel better if
they keep moving during the headache.

Chronic Headaches

Some people start with occasional headaches, but they slowly develop a
pattern of increasingly frequent headaches. Eventually, a chronic daily
headache is present on most days of the week. These chronic headaches
may last for months or even years. Symptoms are usually similar to
tension-type headaches, but features of migraine or cluster headache may
occur.

People who suffer from chronic daily headaches often share two
characteristics. First, they often feel depressed or under stress, and
these symptoms seem to be an important part of their headaches. In some
people, the stress and depression seem to trigger the headaches, whereas
in others, the opposite is true. Regardless of which causes which,
drugs used to treat the mood symptoms are often critical to stopping the
headaches.

Secondly, people with chronic headaches often struggle with the temptation to overuse pain-relieving drugs. Pain relievers temporarily calm their headaches, but as the drugs wear off, withdrawal symptoms and rebound headaches may occur. As more drugs are used, a vicious cycle develops, which ultimately results in more frequent, painful and persistent headaches. Breaking this cycle can be very difficult but is often crucial to stop the headaches. Preventive (rather than pain-relieving) drugs may be a key part of treatment.

Secondary Headaches

Headaches caused by other medical problems are known as secondary
headaches. Secondary headaches may be caused by a variety of medical
conditions. Some of these conditions are very serious or worrisome, but
most are benign (harmless). Examples of secondary headaches include
those caused by:

Brain tumors

Bleeding aneurysms or strokes

Trauma to the head

Meningitis (inflammation of the covering of the brain) or other brain infections

Sinus infections

Dental problems

Arthritis affecting the neck or jaw

Side effects from drugs such as those used to lower blood pressure or treat depression

Withdrawal from drugs such as caffeine or narcotics

Many people have occasional headaches that get better on their
own or go away with over-the-counter drug treatment. Most of these
people never see a health-care provider for their headaches and are none
the worse off.

However, there are several circumstances in which an evaluation by a health-care provider may be useful or important:

Headaches with “red flag” symptoms that may indicate a serious underlying medical problem

Headaches that do not get better with over-the-counter drugs

Severe headaches that interrupt work or the enjoyment of daily activities

Daily headaches

If you do see a health-care provider about your headaches, make
sure that he or she understands your concerns. Consider writing down
notes or a specific list of questions before your visit. Examples
include the following:

What type of headaches am I having?

Is there anything I can do to prevent the headaches?

Are my headaches likely to come back in the future?

What treatments are available?

Try to make your headaches the main reason for your visit. If
you mention your headaches along with several other problems, your
health-care provider may not have adequate time to perform a through
evaluation.

Red Flags

Many people worry that their headaches are caused by a serious
medical problem, such as a brain tumor, aneurysm, stroke or infection.
In fact, it is quite rare for this to be the case. Although headaches
may be a symptom when something goes wrong with the brain, it is very
uncommon for headaches to be the only symptom. Health-care providers
usually worry about a patient’s headaches only when certain “red flags”
(warning signs) are present, such as:

Headaches that are getting worse over time

New headaches in a person older than 40

The “worst headache of my life”

Severe headaches that start suddenly (often known as “thunderclap” headaches)

Headaches that worsen with exercise, sexual intercourse, coughing or sneezing

Headaches with unusual symptoms, such as passing out, loss of vision or difficulty walking or speaking

Headaches in a person with certain medical problems, including high blood pressure, cancer or AIDS

Headaches in a person with a family history of brain aneurysms

Abnormal findings on neurological exam, such as abnormal eye movements, difficulty walking or weakness in an arm or leg

It is important to keep in mind that, even when these red flag
symptoms are present, most people do not have a serious underlying cause
for their headaches. However, your health-care provider may rely on
these symptoms to decide whether further evaluation — such as a computed
tomography (CT) or magnetic resonance imaging (MRI) scan — is
necessary.

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